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Patel J, More S, Sohani P, Bedarkar S, Dinesh KK, Sharma D, Dhir S, Sushil S, Taneja G, Ghosh RS. Sustaining the mobile medical units to bring equity in healthcare: a PLS-SEM approach. Int J Equity Health 2024; 23:175. [PMID: 39218941 PMCID: PMC11367909 DOI: 10.1186/s12939-024-02260-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Equitable access to healthcare for rural, tribal, and underprivileged people has been an emerging area of interest for researchers, academicians, and policymakers worldwide. Improving equitable access to healthcare requires innovative interventions. This calls for clarifying which operational model of a service innovation needs to be strengthened to achieve transformative change and bring sustainability to public health interventions. The current study aimed to identify the components of an operational model of mobile medical units (MMUs) as an innovative intervention to provide equitable access to healthcare. METHODS The study empirically examined the impact of scalability, affordability, replicability (SAR), and immunization performance on the sustainability of MMUs to develop a framework for primary healthcare in the future. Data were collected via a survey answered by 207 healthcare professionals from six states in India. Partial least squares structural equation modeling (PLS-SEM) was conducted to empirically determine the interrelationships among various constructs. RESULTS The standardized path coefficients revealed that three factors (SAR) significantly influenced immunization performance as independent variables. Comparing the three hypothesized relationships demonstrates that replicability has the most substantial impact, followed by scalability and affordability. Immunization performance was found to have a significant direct effect on sustainability. For evaluating sustainability, MMUs constitute an essential component and an enabler of a sustainable healthcare system and universal health coverage. CONCLUSION This study equips policymakers and public health professionals with the critical components of the MMU operational model leading toward sustainability. The research framework provides reliable grounds for examining the impact of scalability, affordability, and replicability on immunization coverage as the primary public healthcare outcome.
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Affiliation(s)
- Jignesh Patel
- Jivika Healthcare Private Limited, Pune, Maharashtra, India
| | - Sangita More
- Jivika Healthcare Private Limited, Pune, Maharashtra, India
| | - Pravin Sohani
- Jivika Healthcare Private Limited, Pune, Maharashtra, India
| | | | | | - Deepika Sharma
- Department of Management Studies, Indian Institute of Technology Delhi, Delhi, India.
| | - Sanjay Dhir
- Department of Management Studies, Indian Institute of Technology Delhi, Delhi, India
| | - Sushil Sushil
- Department of Management Studies, Indian Institute of Technology Delhi, Delhi, India
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Coaston A, Lee SJ, Johnson JK, Weiss S, Hoffmann T, Stephens C. Factors associated with mobile medical clinic use: a retrospective cohort study. Int J Equity Health 2023; 22:195. [PMID: 37749529 PMCID: PMC10521435 DOI: 10.1186/s12939-023-02004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/05/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Mobile medical clinics have been used for decades to provide primary and preventive care to underserved populations. While several studies have examined their return on investment and impact on chronic disease management outcomes in the Mid-Atlantic and East Coast regions of the United States, little is known about the characteristics and clinical outcomes of adults who receive care aboard mobile clinics on the West Coast region. Guided by the Anderson Behavioral Model, this study describes the predisposing, enabling, and need factors associated with mobile medical clinic use among mobile medical clinic patients in Southern California and examines the relationship between mobile clinic utilization and presence and control of diabetes and hypertension. METHODS We conducted a retrospective cohort study of 411 adults who received care in four mobile clinic locations in Southern California from January 1, 2018, to December 31, 2019. Data were collected from patient charts on predisposing (e.g., sex, race, age), enabling (e.g., insurance and housing status), and need (e.g., chronic illness) factors based on Andersen's Behavioral Model. Zero-truncated negative binomial regression was used to examine the association of chronic illness (hypertension and diabetes) with number of clinic visits, accounting for potential confounding factors. RESULTS Over the course of the 2-year study period, 411 patients made 1790 visits to the mobile medical clinic. The majority of patients were female (68%), Hispanic (78%), married (47%), with a mean age of 50 (SD = 11). Forty-four percent had hypertension and 29% had diabetes. Frequency of mobile clinic utilization was significantly associated with chronic illness. Patients with hypertension and diabetes had 1.22 and 1.61 times the rate of mobile medical clinic visit than those without those conditions, respectively (IRR = 1.61, 95% CI, 1.36-1.92; 1.22, 95% CI, 1.02-1.45). CONCLUSIONS Mobile clinics serve as an important system of health care delivery, especially for adults with uncontrolled diabetes and hypertension.
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Affiliation(s)
- Angela Coaston
- California Baptist University, College of Nursing, 8432 Magnolia Ave, Riverside, Ca, 92504, USA.
| | - Soo-Jeong Lee
- University of California, San Francisco, CA, 94143, USA
| | | | - Sandra Weiss
- University of California, San Francisco, CA, 94143, USA
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Balharith M, Alghalyini B, Al-Mansour K, Tantawy MH, Alonezi MA, Almasud A, Zaidi ARZ. Physical accessibility, availability, financial affordability, and acceptability of mobile health clinics in remote areas of Saudi Arabia. J Family Med Prim Care 2023; 12:1947-1956. [PMID: 38024907 PMCID: PMC10657046 DOI: 10.4103/jfmpc.jfmpc_567_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/04/2023] [Accepted: 06/01/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Access to primary healthcare (PHC) services is a significant concern, especially for those living in remote areas. Mobile health clinics (MHCs) are a model widely used to enhance access to healthcare in rural areas. In Saudi Arabia, the Ministry of Health has launched mobile clinics to facilitate access to PHC and increase access to healthcare. This study aims to assess the accessibility of MHCs in rural areas of Saudi Arabia measuring four dimensions of access from the patient's perspective: physical accessibility, availability, financial affordability, and acceptability. Methods A quantitative cross-sectional survey in the form of an interviewer-administered questionnaire was performed on patients who attended mobile clinics between August and October 2020. All these people have been targeted to be interviewed as a nonprobability sample. Data was collected through a survey filled out by the interviewer. Results Five hundred participants were interviewed in nine mobile clinics in the nine cities of the Kingdom. The majority were men (82.4%) and from Makkah city (13.6%) and 94.2% of the participants were Saudi nationals. In total, 98.3% of the respondents were satisfied with the overall mobile clinic services and 11.4% of the participants had difficulties with the mobile clinics' work schedules. There was a positive correlation between access to mobile clinics and satisfaction. Conclusions The mobile clinics in rural and remote areas in Saudi Arabia during the study period were accessible to the respondents and met patient satisfaction. Most participants accept the work schedule for mobile clinics. However, it requires further improvements to meet all access dimensions of the study.
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Affiliation(s)
- Manea Balharith
- Family and Community Medicine Department, Alfaisal University, Riyadh, Saudi Arabia
| | - Baraa Alghalyini
- Family and Community Medicine Department, Alfaisal University, Riyadh, Saudi Arabia
| | - Khalid Al-Mansour
- Department of Social Studies, College of Arts, King Saud University, Riyadh, Saudi Arabia
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Zhang X, Liu Y, Li X, Sun J. Health IT in our daily life: impact of mobile phone use on the emotions and compliance of diabetes patients. INFORMATION TECHNOLOGY & PEOPLE 2022. [DOI: 10.1108/itp-06-2020-0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
PurposeLeveraging information technology (IT) to improve the treatment and support of patients is a widely studied topic in healthcare. For chronic diseases, such as diabetes, the use of information technology is even more important since its effect extends from a clinic environment to patients’ daily life. The purpose of this paper is to investigate the impacts of one widely adopted information technology, the mobile phone, on diabetes treatment, specifically on the complicated process of patients’ health, emotions and compliance.Design/methodology/approachWe leverage a unique longitudinal dataset on diabetes patients’ health status in rural areas of China to study the problem. We also cross-link the dataset with mobile carrier data to further differentiate mobile phone use to phone calls and network use. To address the endogeneity concerns, we apply PSM and a series of instrument variables.FindingsWe identify clear evidence that mobile phone use can significantly improve patients’ emotions and compliance, where the effect is generally larger on patients in worse health conditions. While mobile phone calls clearly benefit diabetes patients, we do notice that mobile phone network use has a negative moderating effect with patients’ health condition on improving compliance.Originality/valueThis study not only enriches our theoretical understanding of the role of mobile phones in diabetes management, it also shows the economic benefit of promoting patients’ use of mobile phones, which should be considered by medical care providers and medical policymakers.
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Hanh TTD, Ngoc LB, Hoa LN, Gong E, Tao X, Yan LL, Minh HV. Improving prevention of cardiovascular diseases: Barriers and facilitators in primary care services in Vietnam. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2020.1757858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Le Bich Ngoc
- Hanoi University of Public Health, Hanoi, Vietnam
| | - Lam Ngoc Hoa
- Hanoi University of Public Health, Hanoi, Vietnam
| | - Enying Gong
- Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China
| | - Xuanchen Tao
- Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China
| | - Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China
- Global Health Institute, Duke University, Durham, NC, USA
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Baker DR, Cadet K, Mani S. COVID-19 Testing and Social Determinants of Health Among Disadvantaged Baltimore Neighborhoods: A Community Mobile Health Clinic Outreach Model. Popul Health Manag 2021; 24:657-663. [PMID: 34030489 DOI: 10.1089/pop.2021.0066] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective was to summarize data on coronavirus disease 2019 (COVID-19) testing uptake, social determinants of health, and patient satisfaction with mobile health clinic services within underserved minority and low-income communities. This COVID-19 pilot project was conducted during June and July 2020 in low-income residential neighborhoods in West Baltimore, Maryland. Quantitative data were collected and assessed cross-sectionally. Demographically, 85% of the patients identified as Black or African American (n = 265) and 58.2% as female (n = 184). The COVID-19 test was administered by the registered nurse to 78.2% (n = 288) of the patients. More than 90% of patients confirmed high levels of satisfaction with the services they received from the community mobile health clinic. Social determinants were assessed and females reported significantly worse health literacy than their male counterparts (P < 0.05). Study findings suggest that the community mobile health clinic model was effective in attracting hard-to-reach and marginalized individuals, who otherwise may have gone untested or undiagnosed. This care delivery model can be one solution to disparities by improving access to COVID-19 testing and primary care for communities with higher vulnerability to COVID-19 complications.
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Affiliation(s)
- David R Baker
- Department of Population Health, LifeBridge Health, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kechna Cadet
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan Mani
- Department of Population Health, LifeBridge Health, Baltimore, Maryland, USA
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Hardin HK, Alchami H, Lee D, Jones MS. Unmet health need and perceived barriers to health care among adolescents living in a rural area. CHILDRENS HEALTH CARE 2020; 50:108-123. [PMID: 33424079 PMCID: PMC7787257 DOI: 10.1080/02739615.2020.1833333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study investigated the perceived health care needs, unmet health need, and barriers to health care in 224 rural-dwelling adolescents. A cross-sectional, descriptive design was used to survey adolescents attending a public high school in a low-resource, rural Indiana community. One in five adolescents reported an unmet health need. The most common barriers to health care were related to access, apathy, anxiety, and parenting issues. Implications include confidentiality protocols in family healthcare practices, school-based health centers, and intervention research targeting adolescents' communication skills and healthcare consumer skills.
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Affiliation(s)
- Heather K. Hardin
- Case Western Reserve University, Frances Payne Bolton School of Nursing
| | - Hana Alchami
- Case Western Reserve University, Frances Payne Bolton School of Nursing
| | - David Lee
- Case Western Reserve University, Frances Payne Bolton School of Nursing
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Bertoncello C, Cocchio S, Fonzo M, Bennici SE, Russo F, Putoto G. The potential of mobile health clinics in chronic disease prevention and health promotion in universal healthcare systems. An on-field experiment. Int J Equity Health 2020; 19:59. [PMID: 32357888 PMCID: PMC7195790 DOI: 10.1186/s12939-020-01174-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 04/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile health clinics (MHCs) are recognized to facilitate access to healthcare services, especially in disadvantaged populations. Notwithstanding that in Europe a wide-ranging background in mobile screening units for cancer is shared, evidences about MHCs targeting also at other non-communicable diseases (NCDs) in universal health coverage systems are scarce. The aim of this study was to describe the population attracted with a MHC initiative and to assess the potential of this tool in prevention and control of NCDs. METHODS Our MHC was set up in a railway wagon. Standard body measurements, finger-stick glucose, total cholesterol and blood pressure were recorded. Participants were asked about smoking, physical activity, diet, compliance to national cancer screening programmes and ongoing pharmacological treatment. One-to-one counselling was then provided. RESULTS Participants (n = 839) showed a higher prevalence of overweight/obesity, insufficient intake of vegetables, sedentary lifestyle, and a lower compliance to cancer screening compared with reference population. Our initiative attracted groups at higher risk, such as foreigners, men and people aged from 50 to 69. The proportion of newly diagnosed or uncontrolled disease exceeded 40% of participants for both hypertension and hypercholesterolemia (7% for diabetes). Adherence rate to counselling was 99.4%. CONCLUSIONS The MHC was effective in attracting hard-to-reach groups and individuals who may have otherwise gone undiagnosed. MHCs can play a complementary role also in universal coverage health systems, raising self-awareness of unreached population and making access to primary health care easier.
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Affiliation(s)
- Chiara Bertoncello
- Hygiene and Public Health Unit, DCTVSP Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35131, Padova (PD), Italy
| | - Silvia Cocchio
- Hygiene and Public Health Unit, DCTVSP Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35131, Padova (PD), Italy
| | - Marco Fonzo
- Hygiene and Public Health Unit, DCTVSP Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35131, Padova (PD), Italy.
| | - Silvia Eugenia Bennici
- Hygiene and Public Health Unit, DCTVSP Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35131, Padova (PD), Italy
| | - Francesca Russo
- Organizational Unit Prevention and Public Health, Venice, Veneto Region, Italy
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Cerf ME. Health worker resourcing to meet universal health coverage in Africa. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1693711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Marlon E. Cerf
- Grants, Innovation and Product Development, South African Medical Research Council, Cape Town, South Africa
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
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Selby P, Voci S, Zawertailo L, Baliunas D, Dragonetti R, Hussain S. Public health impact of a novel smoking cessation outreach program in Ontario, Canada. BMC Public Health 2018; 18:1117. [PMID: 30217187 PMCID: PMC6137944 DOI: 10.1186/s12889-018-6012-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background Provision of evidence-based smoking cessation treatment may contribute to health disparities if barriers to treatment are greater for more disadvantaged groups. We describe and evaluate the public health impact of a novel outreach program to improve access to smoking cessation treatment in Ontario, Canada. Methods We partnered with Public Health Units (PHUs) located across the province to deliver single-session workshops providing standardized evidence-based content and 10 weeks (2007–2008) or 5 weeks (2008–2016) of nicotine replacement therapy (NRT). Participants completed a baseline assessment and were followed up by phone or e-mail at 6 months. We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework to evaluate the public health impact of the program from 2007 to 2016. Given the iterative design and changes in implementation over time, data is presented annually or bi-annually. Results There were 26,122 enrollments from 2007 to 2016. Between 31 and 442 workshops were held annually. The annual reach was estimated to be 0.1–0.3% of eligible smokers in Ontario. Participants were older, smoked more heavily, had a lower household income, were more likely to be female and be diagnosed with a mood or anxiety disorder, and less likely to have a postsecondary degree compared to average Ontario smokers eligible for participation. The intervention was effective; at 6-month follow-up 22–33% of respondents reported abstinence from smoking. Adoption by PHUs was 81% by the second year of operation and remained high (72–97%) thereafter, with the exception of 2009–2010 (33–56%) when the program was temporarily unavailable to PHUs due to lack of funding. Implementation at the organizational level was not tracked; however, at the individual level, approximately half of participants used most or all of the NRT received. On average, maintenance of the program was high, with PHUs conducting workshops for 7 of the 10 years (2007–2016) and 4 of the 5 most recent years (2012–2016). Conclusions The smoking cessation program had a high rate of adoption and maintenance, reached smokers over a large geographic area, including individuals more likely to experience disparities, and helped them make successful quit attempts. This novel model can be adopted in other jurisdictions with limited resources.
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Affiliation(s)
- Peter Selby
- Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T 1P7, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada. .,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Sabrina Voci
- Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T 1P7, Canada
| | - Laurie Zawertailo
- Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T 1P7, Canada.,Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Dolly Baliunas
- Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T 1P7, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Rosa Dragonetti
- Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T 1P7, Canada
| | - Sarwar Hussain
- Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T 1P7, Canada
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Bouchelle Z, Rawlins Y, Hill C, Bennet J, Perez LX, Oriol N. Preventative health, diversity, and inclusion: a qualitative study of client experience aboard a mobile health clinic in Boston, Massachusetts. Int J Equity Health 2017; 16:191. [PMID: 29100517 PMCID: PMC5670702 DOI: 10.1186/s12939-017-0688-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 10/30/2017] [Indexed: 12/03/2022] Open
Abstract
Background There are approximately 2000 mobile health clinics operating in the United States. While researchers have established that mobile health clinics can be cost effective and improve outcomes, there is scant research examining the healthcare experience on a mobile health clinic from patients’ perspectives. Methods Data were gathered from interviews with 25 clients receiving care on a Boston-based mobile health clinic and analyzed using grounded theory methodology. Results Emerging patterns in the data revealed three relational and three structural factors most significant to participants’ experience of care on The Family Van. Relational factors include providers who 1) Communicate understandably, 2) Create a culture of respect and inclusivity, and 3) Are diverse with knowledge of the community. Structural factors include 1) A focus on preventative health and managing chronic disease, 2) Expeditious, free, and multiple services, and 3) Location. Conclusions The participant accounts in this report serve to expand on prior research exploring mobile health clinics’ role in patients’ healthcare, to more clearly define the most salient aspects of the mobile health clinic model for the patients they serve, and to give voice to patients too seldom heard in the academic literature. Electronic supplementary material The online version of this article (10.1186/s12939-017-0688-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zoe Bouchelle
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Yasmin Rawlins
- Columbia University College of Physicians and Surgeons, New York, NY, USA
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